HomeMy WebLinkAboutR 2017-717-E EMS - Excellance ambulance mounting agreement DocuSign Envelope ID: FF7: QS A-4602-AD91-CF4E1D201`117
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Excellance,Inc. Party/Vendor Contact Person: Lisa Barfield Contact Phone: (256)772-9321
Party/Vendor Address: 453 Lanier Rd City Madison State: AL Zip: 35758 Department: Emergency Services
Amount: $105,789.31 after take-off chassis Trade-In credit of$3,500.00 Purpose: Ambulanc Remount#793 Budget
Code(s): 72757530—802000 Vendor#59564 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No
® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date Approved by Board
Yes®No❑ Agenda Date: CIP Budget FYI
This agreement is approved as tter'--;--' f,-w, � A^^^*Ant:
Department Director's Signature Date:g pp ter'--;--' by:
, �tVi#,S 12/6/2017
5655BC891AI34473...
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficiencv of insurance standards, specifications,and requirements:
UocuSigned by:
Office of the Risk Management Office ausa�emdb Date:121712017
7FDCF9176800498...
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act:
Docu5igned by:
Office of the Chief Financial Officer AI" Date: 12/8/2017
704E5181ACC1409...
Legal Services
This agreement is approved as to 1P 1 fr.rrr,nnrl c„ff;r;Pncy:
OocuSigned by:
ry
Office of the County Attorney ����,.1;rt1A1�_ Date: 12/14/2017
4035CB8304CA4M...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkoran eg coun. c..ov
The following signature block is for hard copies only and is not required for Docusign contracts:
Revised 12/17